Men’s health issues in asia

Abstract

Men’s health has gained prominence over the past few years but it is still not on par with the attention or funding that women and child health is getting. In Asia, this issue is even more conspicuous. With westernization of lifestyle, Asian men’s problems emulate their Western counterparts but there are certain issues unique to Asian men due to cultural differences. This review will discuss the health issues affecting Asian men and suggest measures that can be taken to overcome them.

• Asia
• health
• intervention
• men
• problem

Introduction

Recently, we have seen men’s health issues being propelled to the forefront of healthcare, as it has taken a back seat for the past few years. Previously, when we talk about men’s health, it focused primarily on andrology and urology. Nowadays, it has opened up to include psychology, mental, social, quality of life as well as a myriad of other medical illness under the purview of the physicians. Why the sudden “awakening” to this problem?

It all boils down to the issue of aging. As we all know, the lifespan of the world population has been increasing over the years, thanks to the advances of science and medicine. In fact, it is in Asia that we can find the majority of the world’s aging population and this will continue in the future. It has been estimated that by 2040, the proportion of population older than 65 years in Asia is projected to be 14% compared to 7% in 2008. Compounding this matter, the rate of aging in Asian countries (of which the majority is developing nations) is also much faster than developed nations. In Asia, the average lifespan for men in Japan and Singapore in 2008 was among the longest in the world at 79 years [1]. With increasing proportion of aging men in the population, if their health is not well taken care of, we will see a reduction in productivity. Thus, the need to address men’s health needs.

Key issues

The prevalence of diabetes mellitus (DM) has been increasing throughout Asia and the rate has been a lot quicker than the West. The World Health Organization estimated that 80 million out of 171 million individuals with DM worldwide lived in Asia in 2000. These numbers are projected to double by the year 2030, with the greatest increase expected in Asia [2]. East Asian patients with type 2 diabetes have a higher risk of developing renal complications than Europeans and, with regard to cardiovascular complications, a predisposition for developing strokes [3].

The prevalence of obesity is also increasing throughout Asia [4]. Lifestyle as well the diet associated with a more developed world contributes to this. Where men used to toil in the field under the sun, nowadays men just sit behind their desks in air-conditioned rooms with hardly any calories expended. This sedentary lifestyle is to be blamed for the increasing waist line, leading to the much feared metabolic syndrome [5]. Henceforth, it is hardly surprising that cardiovascular disease has replaced communicable diseases as the main cause of death in Asia [1].

With advancing age, the incidence of certain cancers increases too. These includes lung, colorectal and prostate cancer though the incidence of prostate cancer in Asia is much lower compared to the West. The rate of cardiovascular as well as cerebral events also rises with aging but interestingly, the rate of coronary heart disease is much lower among Asians compared to the Western world. Conversely, the rate of stroke is higher among Asians [6].

What is worrying is that despite the fact that the rates of all these diseases are increasing with the population of aging men, there is still a lack of awareness among the male population on these issues [7,8]. Men’s progress in health is largely impeded by their poor health seeking behavior. This in turn is largely influenced by society and culture. Men tend to adopt a set of masculine health behaviors, such as being stoic and tough, to live up to the expectation of society at large [9–12]. Men with illnesses and psychological ailments are considered weak and are generally not tolerated [13] In a study conducted in Malaysia, it was noted that there was large percentage of men with hypertension (19%), diabetes (2.8%), LUTS (19.2%) and erectile dysfunction (44.5%) who were under-detected or treated [14].

Men are also unwilling to acknowledge illness as readily as women do, are more prone to delaying help-seeking for symptoms, and are also more likely to ignore health screening and preventive health care [15].

So when do men actually look for help? They usually seek treatment for “reparation”; that is after the damage has been done. Diseases like lower urinary tract symptoms (LUTS), testosterone deficiency (TD), erectile dysfunction (ED) and premature ejaculation (PE) all affects their quality of life and this brings them to the doctor’s doorstep. Therefore, we should use this opportunity to engage men via quality of life (QOL) issues. There is ample evidence to show that LUTS, ED, PE and TD may be related to physical diseases like cardiovascular, obesity, diabetes or metabolic syndrome [16–18].

When men present themselves to the doctor complaining of QOL issues like LUTS, ED, PE and TD, it is imperative on the doctor to investigate for other underlying illnesses as well. Quality of life issues are also an opening for doctors to unearth risk factors for metabolic syndrome. For example, the appearance of erectile dysfunction is known to precede symptomatic cardiovascular diseases by an average of 5 years in 66% of men [19].

Therefore, the doctor should take the opportunity to intervene and counsel the patient on his health. Screening for cardiovascular disease as well as lifestyle advice should be offered. Lifestyle modifications besides improving quality of life, will also alter metabolic syndrome factors for the better [20]. This is true for cancer as well. Lifestyle changes such as adopting a diet low in fat and high in fibre-rich starch foods, as well as lots of antioxidants, combined with regular aerobic exercise might control insulin resistance, reduce the resulting serum factors (like insulin growth factor) and thus can reduce the risk for many different cancers [21].

Needs of men

The crux of the issue remains to engage men to care for their health. Before we can embark on this, we need to understand the needs of men. Men on the whole treasure their privacy. They dislike having their physical or psychological boundaries violated. There is pride involved. Getting a digital rectal examination as a routine check up for the prostate is not something pleasant. This can deter men from seeing a doctor.

In order to gain the trust and acceptance of men, doctors also need to tailor the information given accordingly. The knowledge shared should be individualized and would depend on the age and disease. It is of no use barraging their senses with facts from the encyclopedia about all the diseases in the world as this will just scare them off. As mentioned earlier, doctors should use the presenting complaint on the quality of life to link them to other underlying physical illnesses and from there explore the issues involved. This would ensure the patient stays focused and interested.

The key issue which is important to all men is the maintenance of potency; be it physical, sexual or psychological. Men can brush aside other health matters but when potency is involved, they lose out.

Interventions

This brings us to the issue of interventions that can be used to engage men.

Technology

First of all is to harness the advances of technology to reach out to men [22]. Most men nowadays have access to the internet and handphones. This is a gateway for men to assimilate relevant information and knowledge on their health. Everything is now at the fingertips. The advent of the smartphone and tablet has revolutionized the information highway. Nevertheless, with so much writings on the internet, not all are factual information. There is a need to discern and separate the wheat from the chaff. This is where the appropriate authorities or bodies like the relevant medical societies (e.g. Royal College of Physicians) should play their role in dispensing accurate and credible information. Since men are reluctant to go to the doctors, the doctors have to take the initiative to go out to them, communicate with them via technology [23]. In this way, we can reach out to men 24 h a day, even when they are uncomfortable relating to a doctor face to face. The caveat is that to pique their interest, the information given out need to be tailored to the age group, education and social status. However, the problem with this approach is that not all men, especially the older generation, may be technology literate.

Redefining men’s health

Secondly, the definition of men’s health itself needs to be re-looked. The WHO defined health, in 1948, as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity [24]. The European Men’s Health Forum, on the other hand, has provided a more precise and gender sensitive definition of men’s health:” A male health issue is one arising from physiological, psychological, social, cultural or environmental factors that have a specific impact on boys or men and/or where particular interventions are required for boys or men in order to achieve improvements in health and well-being at either the individual or the population level” [25]. There is so much medical jargon in this definition. Health should be simply denoted as men’s fitness and ability to work. This is what most men can relate to. At the same time, health should not be seen as intruding into the privacy of the individual nor violate the boundaries of propriety. However, we need to be careful with oversimplifying the definition of health as it may lead to men ignoring diseases which are asymptomatic an at an early stage.

Educating men on the importance of health after retirement

There is also a need for healthcare workers to understand the shift of generation and transformation of demography. The period between retirement and debilitation/death has been prolonged due to the wonders of science and technology. Having gone through the trials and tribulations of life, men at this twilight of their life are at the peak in terms of experience and wisdom. Their success would have also brought them wealth by the time they reach this period of time. It is henceforth important to be at the best of health when they are at their prime age to enjoy the bounty of their toils. Therefore it is important to get the message across to men that they need to care for their health when they are younger. This means sticking to a healthy lifestyle and go for regular medical check-ups even when they are in their 20 s and 30 s.

Tailor health education according to the local culture

Besides that, interventions also need to be adjusted according to the local culture. Health providers should be aware of the influence of culture and use it to his advantage. For example, in South Asian culture, important masculine traits include placing a high priority on family responsibility as well as a need to be in control [26]. By emphasizing to men that taking care of their own health is about being in control of their own life (empowerment) as well as acting responsibly towards their family, men may actually sit up and listen. The impediment to this is that in certain countries like in Malaysia, there are so many different cultures and the different cultures sometimes have conflicting views as well. This would be a challenge to the health provider.

Doctors as role models and male friendly health policies

It goes without saying also that health care providers should be role models themselves. Male health care providers should lead the way by living a healthy lifestyle, such as by exercising regularly to keep fit and not smoke. Healthcare policies should also be male-friendly [22]. This would encourage men to be more involved in their own health. An example would be to have a special appointment system for men or extend clinic hours after office hours to cater to the tight schedule of working men. In some countries like in Malaysia, phosphodiesterase inhibitors are not subsidized by the government as erectidysfunction is not deemed a serious medical disorder. The myth that this is a social problem should be dispensed off as sexual dysfunction is linked to physical and psychological health [16]. The problem that might be faced here is the issue of budget and manpower.

Improving contact with health professionals

To bring men closer, health professionals should try to understand men’s needs and fears. Men, like women, have emotion and priorities in life. As they approach the golden years, men fear time may not be on their side. The gamut of emotions as they enter andropause also creates havoc. There is also the fear for the unexpected as they embrace the science of sociotechnology, a design which is influenced by culture, belief and value.

The bottom-line is this; all men are afraid of the loss of sexual function, loss of self image/masculinity, cancers and debilitating diseases like stroke and cardiovascular diseases [7–12]. We need to create an awareness among men regarding diseases which may affect them and ways to prevent them. The challenge we face now is to improve contacts between men and healthcare providers or advisors through modern technology. One way to reach out to men is to discretely send subliminal (sensitive and emphatic) messages to men to address their needs and fear through information technology such as smartphones, mass media, workplace as well as sports and leisure facilities where they hangout. In fact, an automated texting intervention for smoking cessation support was found to be effective when evaluated in the UK [23]. Another suggestion would be to revamp the whole healthcare system and have paramedics as primary care advisors [22]. With this, there would be better contact with men especially in the rural areas and the relationship would be more personal.

Again, the impediment here would be the budget and manpower.

Conclusion

Men’s health in Asia lags behind the West partly due to the social and cultural impediments. Men by nature, do not readily admit their shortcomings and failures. This is also true with health. The way forward is to engage men via the social media to create awareness and to empower them to look after their own health rather than to force it on them. The healthcare stakeholders should also realize that men’s health is also of paramount importance and equal attention should be given to it as what the maternal and child health have been receiving.

Declaration of interest

The authors report no conflict of interest.